Dysautonomia

Dysautonomia refers to a disorder of autonomic nervous system (ANS) function. Most forms of dysautonomia involve failure of the sympathetic or parasympathetic components of the ANS, but dysautonomia involving excessive ANS activities such as hypernoradrenergic hypertension also can occur.

Dysautonomia can be local as in reflex sympathetic dystrophy, or generalized as in pure autonomic failure. It can be acute and reversible such as in Guillain-Barre syndrome, or chronic and progressive as in Shy-Drager syndrome.

Several common conditions such as diabetes and alcoholism can include dysautonomia. Dysautonomia also can occur as a primary condition or in association with degenerative neurological diseases such as Parkinson's disease. Diseases with generalized, primary dysautonomia may also include multiple system atrophy and familial dysautonomia.

Hallmarks of generalized dysautonomia due to sympathetic failure are impotence (in men) and a fall in blood pressure during standing (orthostatic hypotension). Excessive sympathetic activity can present as hypertension with a rapid pulse rate.

There is no cure for dysautonomia. Secondary forms may improve with treatment of the underlying disease. In many cases treatment of primary dysautonomia is symptomatic and supportive. Measures to combat orthostatic hypotension include elevation of the head of the bed, frequent small meals, a high-salt diet, and drugs such as fludrocortisone, midodrine, and ephedrine.

The outlook for patients with dysautonomia depends on the particular diagnostic category. Patients with chronic, progressive, generalized dysautonomia have a generally poor long-term prognosis. Death can occur from pneumonia, acute respiratory failure, or sudden cardiopulmonary arrest.

Information provided by the
National Institute of Neurological Disorders and Stroke,
National Institutes of Health

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.